This Week in HIV Research: Quality of Life Is About More Than Viral Suppression

This week, we get an important reminder that an HIV-positive person's sense of wellbeing doesn't start and end with an undetectable viral load. We also look at hair follicles for signs of treatment failure, a viral suppression gender divide among older people in Italy, and the disproportionate financial burden of antiretrovirals on the Swiss HIV care system.

The survey, sponsored by Gilead Sciences, included more than 500 people living with HIV and over 2,700 HIV-negative people in France, Germany, Italy, Spain, and the United Kingdom. Almost a quarter of all respondents living with HIV considered the need to disclose their status a major barrier to dating. More than two-thirds of UK respondents feared disclosure, compared to half in Spain. Only a third of Spaniards living with HIV believed their overall health was at least "good," while more than half of Germans thought so. Overall, fewer than half of survey participants living with HIV rated their health "good" or "excellent," while almost 70% of those not living with HIV did so.

About a third of respondents living with HIV thought they would die before their peers, compared to a tenth of respondents from the general population.

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Viremia Predicted by Medication Levels in Hair

Hair samples could be used to guide treatment decisions in young people living with HIV, particularly in low- and middle-income countries (LMIC), researchers proposed in Journal of Acquired Immune Deficiency Syndrome. They analyzed lopinavir (a component of Kaletra) levels in the hair of more than 240 children on second-line lopinavir-based antiretroviral treatment in Asia and found a strong association between low concentrations of the drug in hair samples and the development of HIV viremia 24 weeks or more after starting their second-line therapy.

Since low medication levels could be the result of suboptimal adherence to the prescribed regimen or insufficient dosing, hair sample data could trigger adherence interventions or dose adjustments, the researchers suggested. However, a low-cost hair testing process is needed to make this approach a viable option in low- and middle-income countries, study authors noted.

The Geriatric Patients Living With HIV/AIDS study tracked people in Italy who live with HIV and are at least 65 years old. Data indicated that 74% of the 210 participating women had a viral load below 50 copies (i.e., had undetectable HIV), compared to 82% of the 1,027 men in the study, a finding that was statistically significant (P = .002), according to NATAP. The lower rate of viral suppression among women could be due to differences in antiretroviral regimens, more negative side effects from medications or interactions between HIV and other drugs, researchers concluded.

The average lowest CD4+ cell count among women was also below that of the men. This may be because women were diagnosed later in the course of their HIV than men, study authors reasoned.

Most other characteristics were similar between the genders, although women were less likely to take a protease inhibitor than men, and were more likely to take lipid-lowering drugs. About half of the women had bone problems, compared to a fifth of the men.

Most of Swiss Health Care Spending for People Living With HIV Used for Antiretrovirals

Information on almost 1,200 members of the cohort during 2012-2013 was matched with insurance records to obtain likely treatment costs for various subgroups. Around three-quarters of the roughly 27,000 Swiss francs (about the same in US$) per person spent on ambulatory care expenses went to antiretroviral drugs. Health care for younger educated men who drink little, do not use street drugs, and adhere to their medication regimen was cheaper than for those with other characteristics, NATAP reported. People in that low-cost group were also less likely to have comorbidities such as psychiatric problems or cardiovascular issues.

Starting HIV care a long time after seroconversion (defined as a CD4+ cell count below 350) did not add significantly to the cost of health care, the study reportedly found -- although this result may be explained by a short follow-up period that didn't allow for the study of comorbidities, one of the study authors explained in a related interview.

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